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Published on: February 12, 2011
Cardiovascular magnetic resonance parametric mapping in the risk stratification of patients affected by chronic
Davide Vignale1,2, Elisa Bruno1,2, Anna Palmisano1,2
1Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Insights
Cardiovascular magnetic resonance (CMR) mapping accurately predicts outcomes in chronic myocarditis patients. The intensity of myocardial damage, combined with left ventricle dysfunction, significantly improves risk stratification for heart failure and arrhythmias.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Chronic myocardial inflammation is a significant cause of morbidity and mortality, often leading to arrhythmias and dilated cardiomyopathy.
- Cardiovascular magnetic resonance (CMR) is the gold standard for detecting myocardial inflammation using sensitive parametric mapping techniques.
- The prognostic value of CMR mapping in chronic myocarditis remains understudied.
Purpose of the Study:
- To evaluate the prognostic capabilities of CMR parametric mapping in patients with chronic myocarditis.
- To assess if quantitative analysis of CMR mapping parameters can improve risk stratification.
Main Methods:
- Retrospective study of 88 patients with suspected chronic myocarditis undergoing CMR (Sept 2017 - Nov 2021).
- CMR imaging followed 2018 Lake Louise Criteria.
- Outcomes included heart failure, chest pain, ICD/PM implantation, and arrhythmias (Lown class ≥2).
- Multivariate logistic regression models incorporating extent/intensity of T1, T2, and ECV alterations, with/without LVEF, were used for prediction.
Main Results:
- 35% of patients experienced adverse outcomes after a median 21-month follow-up.
- A model combining mapping alterations' extent and LV dysfunction showed good predictability (AUC 0.71).
- A model incorporating mapping alterations' intensity and LV dysfunction demonstrated very good performance (AUC 0.80).
Conclusions:
- Quantitative CMR mapping parameters reflecting myocardial damage severity enhance risk stratification in chronic myocarditis.
- Intensity of myocardial damage (native T1, T2, ECV alterations) and LV dysfunction improve patient risk stratification.
- Prospective studies are needed for clinical validation.
Objectives:
Chronic myocardial inflammation is the substrate for arrhythmias and dilated cardiomyopathy onset, causing morbidity and mortality. Cardiovascular magnetic resonance (CMR) is the noninvasive gold standard for myocardial inflammation detection, due to the high sensitivity of the parametric mapping techniques. However, the potential prognostic capabilities of CMR mapping have not been studied in the setting of chronic myocarditis.
Methods:
This is a retrospective study on consecutive patients undergoing CMR with suspicion of chronic myocarditis from September 2017 to November 2021. CMR was acquired according to 2018 Lake Louise Criteria recommendations. The outcome (chronic heart failure, recurrent chronic myocarditic chest pain, ICD/PM implantation, arrhythmias [Lown class ≥ 2]) was collected at follow-up. The extent and degree of native T1, T2, and extracellular volume fraction alterations were used to create multivariate binary logistic regression models for outcome prediction, with or without left ventricle ejection fraction; their AUCs were compared with DeLong test. Differences between other parameters were assessed using Chi-square test, Fisher's exact test, or Mann-Whitney U-test.
Results:
The population included 88 patients (age 43 [32-52] yo), mostly male (53/88, 60%). After a median follow-up of 21 (17-34) months, 31/88 (35%) patients experienced the outcome. The model based on the extension of mapping alterations and LV dysfunction reached a good predictability (AUC 0.71). The model based on the intensity of mapping alterations and LV dysfunction had a very good performance (AUC 0.80).
Conclusion:
The quantitative analysis of CMR mapping parameters indicative of myocardial damage severity may improve risk stratification in patients with chronic myocarditis.
Clinical Relevance Statement:
The intensity of myocardial damage, assessed as the degree of native T1, T2, and ECV alteration, together with left ventricle dysfunction, improved patient risk stratification. Further prospective studies will be necessary for validation before clinical application.
Key Points:
Risk stratification of patients affected by chronic myocarditis is an unmet clinical need. Cardiovascular MRI (CMR) can role in risk stratification thanks to its multiparametric capabilities of tissue characterization. A model based on CMR parametric mapping and left ventricle ejection fraction can predict arrhythmia, heart failure, and recurrent symptoms.
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